Patient Portals: Opening a New Door to Patient-Clinician Communication

  About 5 years ago, my father had a series of terrible strokes. During an emergency hospitalization, it became urgent that I get records from another hospital. The layers of bureaucracy were so deep that even with a signed medical power of attorney, I simply could not get my father’s medical records sent from one hospital to another using the proper channels. Eventually, I had to call the Chief of Staff of the Hospital and say, “Please do me a favor and personally go get my Dad’s records and send them to me.” The problems I encountered were inexcusable. We are supposed to have systems in place that allow medical information to be shared between healthcare providers. What’s more, we need to be able to share the patient’s medical information with the patient. As we move toward greater transparency in healthcare, there is wide acceptance of the concept that sharing information among patients, caregivers, and involved clinicians can improve efficiency and decrease healthcare costs. (How often have clinicians repeated a test because they simply could not get the results of the test someone else had done?) In fact, as part of the HITECH Act, the Obama administration directed incentive payments of more than $20 billion dollars to encourage the “meaningful use” of electronic medical records. One of the meaningful use objectives is to provide patients with an electronic copy of their own health information if they ask for it.   I was enthusiastic about providing patients a copy of their medical information long before the difficulty I experienced with my father’s records. It did not take me long to realize that caring for elderly (often forgetful) patients with numerous (busy, not present during the clinic visit) children would require getting a copy of today’s notes into the patient’s hands. As soon as I adopted the earliest version of the Intellicure EHR at the Memorial Hermann Wound Center in 1997, I began to hand patients a paper copy of my letter to the referring doctor and/or their home nursing orders (it is easy to do this if you implement “point of care” charting). The feedback from patients, family members, and referring doctors was fantastic. I also discovered a dividend: I had to answer fewer and fewer phone calls from patients, family members, and other providers.   Now the HITECH Act has raised the bar on the concept of medical record sharing. Physicians who want to receive bonus money for the meaningful use of an EHR must be able to provide an electronic copy of the medical record to the patient within 48 hours of a patient’s request. In fact, an EHR certified for use under the HITECH program actually has to provide several things to patients. These include:     • Patient-specific education resources     • Patient reminders     • Electronic copy of health information     • Electronic copy of discharge instructions.   (You can find the certification testing procedures at https://healthcare.nist.gov/use_testing/effective_requirements.html.)   Although patient portals — ie, web-based communication tools — are not required under the HITECH program, they provide a great opportunity to meet these requirements. A leader in this area is MD Anderson Cancer Center (MDA). In a recent editorial,¹ Feeley and Shine discuss the MDA secure web-based portal, which went live in 2009. There was no promotion of its launch, and even though I have privileges there and work across the street, I first saw their portal when a patient logged on to it in my exam room. The patient was thrilled she was able to access all her records so easily, and we were quickly able to sort out a question I had about her case. To date, more than 40,000 individuals have viewed their records using MDA’s portal, and more than 1,300 referring physicians have accessed the records of the patients they referred. Drs. Feeley and Shine emphasize that patients are more informed about their care plan and diagnostic results and thus ask smarter, more focused questions. It has certainly made life easier for doctors like me who care for those patients and need to make complex decisions — eg, whether HBOT’s benefits outweigh its risks in a patient with pulmonary disease and radionecrosis. I don’t have to repeat studies or delay treatment waiting for copies of records.   Despite these advantages, patients may be far more enthusiastic about the potential benefits of viewing their records than physicians. A study published in the Annals of Internal Medicine² presents the results from surveys of physicians and patients in three healthcare systems: Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle. The researchers conducted the surveys before starting a year-long trial of electronic note sharing in 2010. Among the 173 primary care physicians contacted, 110 agreed to participate in the “note-sharing” trial. Nearly 38,000 patients completed the surveys. Overall, 69% to 81% of participating physicians in different sites agreed that sharing visit notes with patients would be a good idea, compared with 16% to 33% of nonparticipating doctors. In contrast, 92% to 97% of patients embraced the concept. The most surprising finding of the patient survey was that nearly all patients, regardless of age, educational level, or health status, wanted to see their visit notes. About half said they planned to share the notes with caregivers and other providers. We often have a bias that our elderly and less technologically savvy patients will have limited interest in innovative communication tools. However, I think most patients are excited about better communication with their doctor any way they can get it!   And, while many physicians saw enhanced communication with patients as a major benefit of note sharing, the majority of responding physicians expected that sharing notes would confuse some patients and increase their own work. However, most doctors who have actually incorporated note-sharing find that for every patient who wants you to explain something in the notes, they saved two phone calls from patients who got the information they needed and did not have to call them or their nurses.

How Can a Patient Portal Help Your Clinic?

  Patient portals are usually created by your EHR vendor, but you can hire a company to create one for you separate from your EHR (or even if you use paper charts). They are safe and easy to use. If you are licensing a certified EHR, it likely came with a patient portal that serves the basic functions required for meaningful use. For example, Intellicure licensed a vast repository of expertly designed patient educational resources on various medical conditions, laboratory tests, and studies, which are available in English and Spanish. The IntelliTrak EHR identifies which of those materials pertain to the patient’s diagnosis and posts those materials on the portal for that particular patient. During visits, patients are given unique and secure log-in information. When they go home, they log onto the portal and retrieve patient-specific educational materials, such as well medical records such as continuity- of-care documents (CCDs). This means you no longer have to keep space-consuming paper handouts or brochures all over your clinic. All these materials can now live inside your EHR.   Editor’s Note: Well Care Strategies’ system “TPS EMR” includes a patient portal and so does Net Health’s certified EHR. These portals can serve many time saving functions for the clinician and the wound center. They can allow patients to see their own private set of documents including labs and diagnostics, as well as sending automatic health maintenance reminders and procedure due dates.   Some of the functions a patient portal can serve include:     • Posting patient educational materials     • Posting continuity-of-care documents (CCD)     • Sending/receiving messages to/from the doctor’s office     • Requests for new appointments, prescription refills, and lab reports     • Examination of current and past medical statements     • Entering or modifying personal information and other demographic information     • Receiving emails for reminders, upcoming appointments, and statements.   This technology is still at the early stages of development. Interestingly, in the previously referenced study,2 many caregivers raised HIPAA concerns about the use of patient portals. That is interesting because HIPAA provisions were not intended to keep medical records private from the patient.   I remember when I was a resident at one of our nation’s busiest hospitals (exhausted from days without sleep, which was common then), I would get frustrated with patients who did not know what organs had been removed in their prior operations. I never figured out whether the problem was that the physicians who performed the surgery had been such terrible communicators that they had failed to properly explain the procedure, or if the patients were simply too disorganized to retain any sort of record. The purpose of continuity of care documents and making other medial documents available on a patient portal is to ensure that patients understand, as much as possible, what is happening to them, and to ensure clinicians can work collaboratively using those records.   Bill Gates is quoted as saying that any tool that enhances communication has profound effects in terms of how people can learn from each other and how they can achieve the kind of freedoms that they’re interested in. I would say that patient portals are a great start at enhancing patient/clinician communication and eventually at achieving greater patient and caregiver satisfaction and freedom.

References

1. Feely TW, Shine KI. Access to the medical record for patients and involved providers: transparency through electronic tools. Ann Intern Med. 2011;155:853-854. 2. Walker J, Leveille SG, Vodicka E, Darer JD, Dhanireddy S, Elmore JG, Feldman HJ, et al. Inviting patients to read the doctors’ notes: patients and doctors look ahead. Ann Intern Med. 2011;155:811-819.